1 - (IOP 29) Vicarious Exposure to Heterosexism-based Stress Elicits Alcohol, Cannabis, and Nicotine Craving Among Sexual Minority Young Adults: An Experimental Study

Objective: Sexual minority young adults are at heightened risk for alcohol, cannabis, and nicotine use compared to their heterosexual peers. Heterosexism-based stressors (e.g., discrimination) are a risk factor and often explain sexual orientation inequities in substance use outcomes. Most prior work has primarily relied on correlational designs, and little work has focused on drug craving, a key mechanism in addiction. This study examined the effects of vicarious exposure to heterosexism-based stress on alcohol, cannabis, and nicotine craving among sexual minority young adults using a novel experimental heterosexism mood induction paradigm. We also examined the moderating effects of factors that could influence the impact of vicarious exposure to heterosexism-based stress on drug craving.

Methods: Participants were 281 sexual minority young adults, ages 18-29 (M = 24.93 years old; SD = 2.77), recruited from an online research panel (47% cisgender women; 60% bisexual; and 31% racial and ethnic minorities). Participants completed two online mood induction trials over two separate days (i.e., heterosexism and neutral) and self-report measures.

Results: Vicarious exposure to heterosexism-based stress elicited more alcohol, cannabis, and nicotine craving than the neutral mood induction; results remained significant when controlling for demographic variables, stress appraisal, lifetime heterosexism stressors, addiction severity, and counterbalance effects. Exposure to heterosexism-based stress had medium effects on alcohol and cannabis craving among participants who endorsed greater childhood neglect, whereas the effects were no longer significant for those who had lower childhood neglect. Heterosexism-based stress had medium effects on alcohol craving among participants with lower (vs. higher) levels of distress tolerance. Heterosexism-based stress induced cannabis craving only among participants who grew up in states with higher (vs. lower) structural heterosexism. Lastly, compared to monosexual participants, plurisexual (e.g., bisexual) participants reported greater nicotine craving after exposure to vicarious heterosexism. Other demographic variables, lifetime heterosexism stressors, stress appraisal, addiction severity were not significant moderators.

Conclusions: This study’s findings indicate that vicarious exposure to heterosexism elicits alcohol, cannabis, and nicotine craving among sexual minority young adults. Some of these effects were larger among those with greater childhood neglect, lower distress tolerance, greater structural heterosexism, and for plurisexual individuals. These findings have implications for oppression-based stress models and provide trauma-informed targets for intervention (e.g., distress tolerance, childhood neglect).